Healthcare Provider Details

I. General information

NPI: 1659862753
Provider Name (Legal Business Name): ABITA EYE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 SHERIDAN ST # 102B
HOLLYWOOD FL
33021-1407
US

IV. Provider business mailing address

4330 SHERIDAN ST # 102B
HOLLYWOOD FL
33021-1407
US

V. Phone/Fax

Practice location:
  • Phone: 954-287-2010
  • Fax: 305-723-1910
Mailing address:
  • Phone: 954-287-2010
  • Fax: 305-723-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN BACH
Title or Position: OWNER
Credential: DO
Phone: 954-287-2010